White Rock Dance

Photo Release for Minors

School Name    

Minor’s Name  

Parent/Guardian Information


City State    Zip   


Photo Release for Minors

I, , give White Rock Dance permission to record the image and/or voice of the minor named below, and I grant White Rock Dance all rights to use these sound, still, or moving images in any medium for educational, promotional, advertising, or other purposes. I agree that all rights to the sound, still, or moving images belong to White Rock Dance.





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White Rock Dance https://whiterockdance.com
Signature Certificate
Document name: Photo Release for Minors
Unique Document ID: c797a91847688526becd0acc40e9f9aca277c779
Timestamp Audit
2015-06-07 19:17:36 CDTPhoto Release for Minors Uploaded by Karissa L Agnew - whiterockdance@gmail.com IP